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Mental health experts: No easy answers to explain school shooters

Ever since a 20-year-old man walked into a Connecticut elementary school and murdered 20 small, defenseless children, millions around the world have been asking how and why.

Those who have devoted their lives to understanding mental illness have been asking the same questions and are cautioning against simple answers or a clear explanation.

We may never have real answers, they said.

“We try to make rational sense out of something that there may never be a rational answer for,” said Ken Norton, executive director of the state chapter of the National Alliance on Mental Illness.

“How is it that you can make any sense of what just occurred?”

Psychiatrists and mental health advocates interviewed for this story made clear that it is impossible to know, and irresponsible to speculate about what caused Adam Lanza to murder his mother and 25 others on Friday.

There are just too many things that can cause a person to commit such evil.

And, even though it’s clear something was wrong with Lanza, it might not have been a diagnosable mental illness, which covers a variety of disorders in which a person’s thoughts, emotions or behavior are so abnormal as to cause harm to themselves or others.

“Ultimately, some people are just bad people,” said Dr. Benjamin Nordstrom, a professor of psychiatry at the Geisel School of Medicine at Dartmouth. “Some people are just awful, awful human beings and we’re just not at a point where we understand why that is.”

That said, there are a number of things that experts do understand enough to diagnose in a person. With enough support and intervention, the mentally ill can be treated and live productive lives.

“You probably walk past them every day on Main Street, and you would never know (they had a mental illness),” said Louis Josephson, CEO of Riverbend Community Mental Health Inc. in Concord. “I assure people they are very safe.”

So what types of illnesses, if left untreated, can lead to violence? For starters, those that lead to psychosis, doctors said.

Schizophrenia, which can develop over months, makes it difficult for a person to tell the difference between what is real and not real. It also makes it difficult for them to think clearly, have normal emotional responses or act normally in social situations.

People who develop paranoid schizophrenia could begin to think someone or something is trying to hurt them and act to stop it, Josephson said.

“They are believing that their relative is out to get them or it’s the devil or something, and in the throes of their psychosis, where they’ve totally broken with reality, they do something horrible,” he said. “When they’re in treatment and they’re on medication, they’re like ‘Oh my god, what did I do? I didn’t know what I was thinking.’ ”

Those people are usually frightened and are able to be treated, Josephson and others said.

Other diagnosable illnesses related to fluctuations in brain chemistry, such as depression, mania and bipolar disorder – in which people swing back and forth between very good moods and depression – can also develop into a psychosis if left unchecked.

People abusing drugs such as alcohol and methamphetamine can also become psychotic, Nordstrom said.

Doctors pointed to another, frightening realm of illness for which there is no known cure and a link to violence: personality disorders.

It’s an umbrella term for a variety of more specific diagnoses, but some of them, including antisocial personality disorder, are often associated with psychopaths. Think: Adolescent fire-starters and cat torturers.

Children who have been abused or neglected can develop such disorders, doctors said, but so can children from stable and loving homes. It’s a mystery, and some disagree whether these disorders even qualify as illnesses.

And not all aggression is a sign of mental illness.

“So if you look in the broader scheme of things, being raised in poor environments is often associated with increased rates of aggression,” said Dr. Joffree Barrnett, associate medical director for child and adolescent services at New Hampshire Hospital and a professor at Dartmouth. So, too, he said is being exposed to domestic violence and other traumas.

“As you grow older you kind of accumulate risk factors,” Barrnett said.

But a young person raised in a tough environment – even one who gets in fights or tortures small creatures – isn’t necessarily going to shoot up a school.

There are really complicated reasons why people do what they do, said Dr. Daniel Potenza,the psychiatric medical director of the New Hampshire Department of Corrections.

“People who are violent, it’s a big Venn diagram,” Potenza said. “Some may be sociopathic. Some may be criminal. Some may have some mental health disturbance. Some may have had progressive negative experience in their life and not have a mental illness but just have not a lot of regard for other people.”

It’s possible that things we can’t identify now can, in the future, be identified and diagnosed. But even then, Nordstrom said, biological and chemical explanations may be too reductionistic.

Love, for example, can be explained through neuroscience, he said. But is that the best explanation for love?

Until we get better at identifying which people are likely to become violent, he and others said, it’s best to keep support structures strong for those vulnerable to mental illness to prevent situations from getting out of hand.

“It’s not just one diagnosis or one kind of problem that leads to this,” Nordstrom said. “It’s lots of them, and people – they have to come to help’s attention so that we can try to do something about it.”

(Molly A.K. Connors can be reached at 369-3319 or or on Twitter @MAKConnors )

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